Provider Demographics
NPI:1437820321
Name:BEASLEY, AMBER NICOLE (MSW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 W ORANGE GROVE RD APT 4101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4004
Mailing Address - Country:US
Mailing Address - Phone:520-965-5468
Mailing Address - Fax:
Practice Address - Street 1:790 E SANTA CLARA ST STE 100
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2965
Practice Address - Country:US
Practice Address - Phone:805-585-1860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-202021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical